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Background: Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied., Purpose: The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan., Methods: A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis., Results: Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. "Desire to know the reasons for discomfort" and "discharge date" were the messages most expected by the participants., Conclusions: This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians. Written materials and the involvement of principal caregivers in the medical informing process may be necessary. Besides, before providing medical information, medical professionals should be cognizant of the key concerns of their patients.

Background: Respect for the autonomy of patients is essential in life-threatening medical decisions such as surgery. Even if a patient has the competency to make decisions, many obstacles exist that may influence his or her willingness to participate in the surgical decision-making process., Purpose: The aim of this study was to explore the perceived difficulties in surgical decision making and related factors among elective surgical patients., Methods: This was a cross-sectional correlational study. A convenience sampling method was used to recruit patients from a medical center in southern Taiwan. Patients who had received elective surgery, were older than 20 years old, and were competent to make medical decisions were invited to participate. A structured questionnaire was developed by the researchers to collect demographic data, decision patterns, and perceived difficulties in surgical decision making. Acceptable validity and reliability of the questionnaire were confirmed before data collection., Results: Over 80% of the participants made the surgical decision by themselves or in collaboration with their family or physician. Less than 15% expected to make the surgical decision by themselves. Illness-related suffering was the greatest difficulty that participants faced. The patients who tended toward passive decision making faced greater difficulties in the dimensions of "do not understand information," "physician's lack of concern," and "difficulty in freely communicating with the physician" than their active decision-making peers. Male participants reported having more difficulty in communicating with their physician than their female peers. Age, education, and marital status were not significantly associated with perceived difficulties in surgical decision making., Conclusions: Family participation in the medical decision-making process is expected by most patients. Although less than 20% of the participants in this study were categorized as passive decision makers, this group reported more difficulties than the active decision-making group. Healthcare professionals should be more active in communicating with patients who are largely silent during the decision-making process to elicit their preferences and needs with regard to surgical decisions.

Background: Stroke is the third leading cause of death in Taiwan. Poststroke older adults are often admitted to long-term care facilities. The impacts of the two concurrent life events of stroke and relocation may increase the risk of depression in stroke survivors. Depression in elderly stroke survivor residents of long-term care facilities has not been studied., Purpose: This study explores the factors associated with depression in older residents with stroke living in long-term care facilities., Methods: A cross-sectional design was used. Twenty-three institutions in southern Taiwan participated in this study, including seven nursing homes, 11 intermediate-care facilities, and five domiciliary-care facilities. Purposive sampling enrolled 111 participants who met the following inclusion criteria: 65 years or older, experienced a stroke that did not cause cognitive defects, and capable of verbal communication. Data were collected using a sociodemographic data questionnaire, Barthel's Index, and the Taiwan Geriatric Depression Scale., Results: Depression was experienced by 41 of the 111 participants (36.9%). Prevalence of depression was 45.7% in nursing homes, 36.2% in intermediate-care facilities, and 22.2% in domiciliary-care facilities. Participants living in nursing homes and intermediate-care facilities and illiterate participants with low Barthel's Index scores showed more depressive symptoms., Conclusions/implications for Practice: Healthcare providers should conduct depression screening for elderly residents with stroke on admission to long-term care facilities. Regular assessment and monitoring of depressive symptoms, especially in residents with less formal education and limited physical functions, are important in nursing homes and intermediate-care facilities.

Quality of life is an important indicator for evaluating therapeutic outcomes and mortality in patients with end-stage renal disease. Few studies have explored the impact of symptom distress and social support on quality of life in this population. A correlational study was designed to examine the influence of symptom distress, social support and demographic characteristics on quality of life in renal transplant recipients. A convenience sample of 113 renal transplant recipients was recruited from a medical center in Southern Taiwan. A structured questionnaire was used to collect data. This four-part tool included: Quality of Life Index--Kidney Transplant Version III, Physical Symptom Distress Scale, Social Support Scale, and demographic characteristics. Data were analyzed by descriptive and inferential statistics (SPSS 10.1 statistical package). Percentage, rank, mean and standard deviation, t-tests, chi-square, ANOVA, Pearson's correlation and multiple regression were computed. Results showed that renal transplant recipients had a moderate quality of life. Social support and symptom distress, age, employment status, and household income significantly explained 28.8% of the variance in quality of life. Findings suggest implications for interventional programming and research aimed toward improving quality of life, including individual and family-based approaches designed to enhance recipients' social support and address effective management of symptoms. Recruiting a transplant clinical nurse specialist to design and implement an intervention program also is recommended.

The purpose of this study was to examine factors affecting the development of nursing competence in the writing of N3 (clinical nurse level III) case reports. A cross-sectional survey was conducted in 13 hospitals in southern Taiwan from July to October, 2002. The subjects included 239 nurses who had passed N3 case report accreditation. The results show that (1) nurses rated their current competence at a fairly good level ( 5.57 +/- 0.74). There was no significant difference between nurses ' subjective self-evaluation and supervisors ' objective evaluation (5.57 +/- 0.74 vs 5.55 +/- 0.89; t = 0.162, p = 0.871). (2) The nurses ' self-rating, supervisors ', and colleagues ' evaluation all indicated moderate progress in nursing competence after writing N3 case reports. The progress scores rated by nurses themselves, supervisors and colleagues were not significantly different (4.89 +/- 1.35 vs. 4.84 +/- 1.57 vs. 4.84 + 1.26; F = 0.096, p =.909). This finding reveals that writing N3 case reports has a positive effect on nursing competence. (3) The results also indicate that ' Attitude toward N3 case report ', 'Writing difficulty ', ' Preparation for writing case report ' were the three predicting factors of progress in nursing competence, which accounted for 26.2 % of the total variance. Therefore we recommend that N3 advancement education should include guidance in alleviating writing difficulty and emphasis on implementing various types of preparation for writing case reports, as effective ways to improve nursing competence.

The purpose of this hermeneutic study was to investigate the essence of spirituality of terminally ill patients. In-depth unstructured interviews were used as the method for data collection. In the six-month period of data collection, the researcher was in the role of a hospice palliative care consultant who directly took care of the subject patients in a hospice ward of a teaching hospital. The six subjects were selected purposively according to various demographic backgrounds. Interview transcripts provided the data for analysis. The results were composed of four constitutive patterns and ten themes. The first constitutive pattern was "Communion with Self" which included three themes: (1) Self-identity--spirituality is the discovery of the authentic self. (2) Wholeness--a human being is full of contradictions but still in wholeness. (3) Inner peace--spirituality is negotiating conflicts for self-reconciliation. The second constitutive pattern was "Communion with others" which included two themes: (1) Love--spirituality is a caring relationship but not an over-attachment to others. (2) Reconciliation--spirituality is to forgive and to be forgiven. The third constitutive pattern was "Communion with Nature" which included two themes: (1) Inspiration from the nature--spirituality is the resonance of the marvelous beauty of nature. (2) Creativity--spirituality is conceiving imaginatively. The fourth constitutive pattern was "Communion with Higher Being" which included three themes: (1) Faithfulness--spirituality is keeping the trust dependably. (2) Hope--spirituality is claiming possibilities. (3) Gratitude--spirituality is giving thanks and embracing grace. The scientific rigor of this qualitative research as well as the strength and limitations of the study are reported. Implications for hospice palliative care and future research are recommended.

The purpose of this study was to compare the differences between head nurses expectations and new graduates perceptions of the entry-level skill competency. Subjects included 147 new graduates and 126 head nurses from four schools of nursing and their affiliated medical centers located in northern, central and southern Taiwan. The results showed that among 213 skills, 153 skills were reported by over 60% of head nurses to be performed precisely under clinical settings. In contrast to the graduates perceptions, over 60% of the graduates had confidence to perform only 82 skills precisely. The percentage of head nurses expectation and the perception of the graduates in skills that were reported to be performed precisely in clinical situations were significantly different in 145 skills (68%). For seventy-six skill items there was congruence between the percentage of head nurses expectations and new graduates perceptions. The percentage of the head nurses expectation were higher than the graduates perception in 55 skills. On the other hand, for 14 skills the percentage of graduates who perceived themselves as being able to perform them precisely was significantly higher than the percentage of head nurses. The results can be applied to improve nursing skills teaching and students pre-job preparation.

Nurses constantly face the need to provide patient care, both physical and psychological, within the health care arena. Nursing staff must have an understanding of the concerns and experiences of hospitalization, and the sensitivity to elicit the patient s own private language of health care needs. The purpose of the study was to examine the concerns of health care needs from patients point of view. The specific objective was to understand the experiences of hospitalized patients. The grounded theory method was applied for this purpose with major assumptions from the symbolic interaction perspective. Twelve subjects were recruited from medical and surgical units at a teaching hospital using purposive sampling, and were interviewed. Data were in the form of transcripts from tapes, field notes, and analytic and process memos. The constant comparative technique was utilized to discover the core themes that would explain most of the variation and integrate the data, codes and memos. Three coding processes, open coding, axial coding, and selective coding, were employed. Six aspects were generated from the results of the study to describe patients concerns. The hospitalized experience was depicted as searching for certain aspects of health care needs including focus on the physical condition, promptness and effectiveness of nursing services, health professionals caring attitudes when giving service and their responsibility, food preparation, environment, and medical expenses.

A novel and promising approach currently available is the grafting of fetal nigra tissues into the brain of a Parkinson's patient. However, the degree of success for such treatment has mainly been evaluated by histological, radiological and physical assessments, with little or no attention paid to its effects on the patient's psychosocial status. In order to provide a more comprehensive profile, a survey was conducted using questionnaires and interviews to examine the physio-psycho-social progress of six Parkinson's patients who underwent fetal tissue grafting in Taiwan. Results indicated that the physiological effects varied among patients. Noticeably an improvement in walking was the most gratifying, but progress in dressing and writing ability seemed disappointing. From the psychological point of view, depression was commonly felt by patients. Other feelings included fear, ambivalence, and change in body image. In addition, all six patients found that their relationship with spouse became worse; they also reduced social interaction to the minimum. From the findings, we also noticed that inadequate knowledge contributed to part of the results. Therefore, some nursing suggestions especially educating the patients and family about the facts and outcome of fetal tissue transplantation are highly recommended. These may help Parkinson's patients adjust better after undergoing this novel treatment.